Pain, Pattern and Polytrauma – Predictors of Sexual Dysfunction in Pelvic Fractures: A Retrospective Multicenter Analysis

Document Type : RESEARCH PAPER

Authors

1 Alrazi Orthopedic Hospital, Alsabah medical region, Kuwait

2 Jaber Alahmed Alsabah Hospital, South Surra, Kuwait

3 Farwaniya Hospital, Farwaniya Governorate, Kuwait

4 Alsalam International Hospital, Bneid Al Gar, Kuwait

Abstract

Objectives: In the local and cultural setting of high trauma rates and a reserved outlook on sexual 
function, this study examines the incidence and underlying factors of sexual dysfunction (SD) following 
pelvic fractures.
Methods: A Multi-center retrospective cohort analysis performed in two general hospitals and one tertiary orthopedic 
center with collection between 2017 and 2019. Consecutive patients with pelvic fractures between January 2017 
and February 2019 were followed up at 18-24 months to screen for new-onset SD using the International Index of 
Erectile Function-5 (IIEF-5) and Female-Sexual-Function-Index-6 (FSFI-6). Additional variables include age, sex, 
Young-Burgess classification, urogenital injury, injury severity score, persisting pain, sacroiliac disruption, 
intervention and if sexual health was discussed or patient referred for sexual healthcare.
Results: One-hundred and sixty-five patients (n = 165) were included, (83%) male, (16%) female with a mean age 
of 35.1 years (Range 18-55). Fracture patterns included lateral compression (LC) (51.5%), anteroposterior 
compression (APC) (27.7%), and vertical shear (VS) (20.6%). The urogenital injury occurred in 10.3%. The mean 
IIEF-5 and FSFI-6 scores were 20.8 and 24.7 in males and females, respectively. A total of 40 males (29%) scored 
below the 21 cut-off scores for SD, while only one female (3.7%) scored below the corresponding score of 19. Of all 
participants reporting sexual dysfunction, 56% discussed sexual health with their providers, while 46% of these 
patients were referred for further management. Significant predictive factors for SD using a multivariate logistic 
regression model include increasing age (OR-1.093, p = 0.006), APC III (OR 88.887, p = 0.006), VS (OR-15.607, p 
= 0.020), persisting pain (OR 3.600, p = 0.021) and increasing injury severity score (OR 1.184, p <0.001).
Conclusion: SD is common among pelvic fractures, and risk factors include APC or VS type fractures, increasing 
age, increasing injury severity score, and persisting pain. Providers should ensure patients are screened for SD and 
referred appropriately as patients may not willingly disclose underlying symptoms.
 Level of evidence: III 

Keywords

Main Subjects

References

1. Giannoudis P V, Grotz MRW, Tzioupis C, et al. Prevalence of
Pelvic Fractures, Associated Injuries, and Mortality: The
United Kingdom Perspective. J Trauma. 2007; 63(4):875–83.
http://dx.doi.org/10.1097/01.ta.0000242259.67486.15
2. Verbeek DO, Ponsen KJ, Fiocco M, Amodio S, Leenen LPH,
Goslings JC. Pelvic fractures in the Netherlands: epidemiology,
characteristics and risk factors for in-hospital mortality in the
older and younger population. Eur J Orthop Surg Traumatol.
2017; 28(2):197–205. http://dx.doi.org/10.1007/s00590-
017-2044-3
3. Pohlemann T, Stengel D, Tosounidis G, et al. Survival trends
and predictors of mortality in severe pelvic trauma: Estimates
from the German Pelvic Trauma Registry Initiative. Injury.
2011; 42(10):997–1002.
http://dx.doi.org/10.1016/j.injury.2011.03.053
4. Odutola AA, Sabri O, Halliday R, Chesser TJS, Ward AJ. High
rates of sexual and urinary dysfunction after surgically
treated displaced pelvic ring injuries. Clin Orthop Relat Res.
2012; 470(8):2173–84. doi: 10.1007/s11999-012-2257-z.
5. Demetriades D, Karaiskakis M, Toutouzas K, Alo K, Velmahos
G, Chan L. Pelvic fractures: epidemiology and predictors of
associated abdominal injuries and outcomes. J Am Coll Surg.
2002; 195(1):1–10. http://dx.doi.org/10.1016/s1072-7515
(02)01197-3
6. Bjurlin MA, Fantus RJ, Mellett MM, Goble SM. Genitourinary
Injuries in Pelvic Fracture Morbidity and Mortality Using the
National Trauma Data Bank. J Trauma Inj Infect Crit Care.
2009; 67(5):1033–9.
http://dx.doi.org/10.1097/ta.0b013e3181bb8d6c
7. Velazquez N, Fantus RJ, Fantus RJ, Kingsley S, Bjurlin MA.
Blunt trauma pelvic fracture-associated genitourinary and
concomitant lower gastrointestinal injury: incidence,
morbidity, and mortality. World J Urol. 2019; 38(1):231–8.
http://dx.doi.org/10.1007/s00345-019-02725-7
8. Guan Y, Wendong S, Zhao S, et al. The vascular and
neurogenic factors associated with erectile dysfunction in
patients after pelvic fractures. Int Braz J Urol. 2015;
41(5):959–66. doi: 10.1590/S1677-5538.IBJU.2014.0170.
9. Johnsen N V, Lang J, Wessells H, Vavilala MS, Rivara FP,
Hagedorn JC. Barriers to Care of Sexual Health Concerns in
Men Following Traumatic Pelvic Fractures. J Sex Med. 2019;
16(10):1557–66.
http://dx.doi.org/10.1016/j.jsxm.2019.07.014
10. Harvey-Kelly KF, Kanakaris NK, Eardley I, Giannoudis P V.
Sexual Function Impairment after High Energy Pelvic
Fractures: Evidence Today. J Urol. 2011; 185(6):2027–34.
http://dx.doi.org/10.1016/j.juro.2011.01.076
11. Kennedy SH, Rizvi S. Sexual Dysfunction, Depression, and the
Impact of Antidepressants. J Clin Psychopharmacol. 2009;
29(2):157–64.
http://dx.doi.org/10.1097/jcp.0b013e31819c76e9
12. Wright JL, Nathens AB, Rivara FP, MacKenzie EJ, Wessells H.
Specific Fracture Configurations Predict Sexual and Excretory
Dysfunction in Men and Women 1 Year after Pelvic Fracture. J
Urol. 2006; 176(4):1540–5.
http://dx.doi.org/10.1016/j.juro.2006.06.044
13. Burgess AR, Eastridge BJ, Young JWR, et al. Pelvic Ring
Disruptions: effective classification system and treatment
protocols. J Trauma Inj Infect Crit Care. 1990; 30(7):848–56.
http://dx.doi.org/10.1097/00005373-199007000-00015
14. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J,
Mishra A. The international index of erectile function (IIEF): a
multidimensional scale for assessment of erectile
dysfunction. Urology. 1997; 49(6):822–30.
http://dx.doi.org/10.1016/s0090-4295 (97)00238-0
15. Isidori AM, Pozza C, Esposito K, et al. Development and
Validation of a 6-Item Version of the Female Sexual Function
Index (FSFI) as a Diagnostic Tool for Female Sexual
Dysfunction. J Sex Med. 2010; 7(3):1139–46.
http://dx.doi.org/10.1111/j.1743-6109.2009.01635.x
16. Shamloul R, Ghanem H, Abou-zeid A. Validity of the Arabic
version of the sexual health inventory for men among
Egyptians. Int J Impot Res. 2004; 16(5):452–5.
http://dx.doi.org/10.1038/sj.ijir.3901248
17. Anis T, Gheit SA, Saied HS, Al-kherbash SA. American
Psychological Association. APA PsycTESTS Dataset.Female
Sexual Function Index—Arabic Version. Available at:
https://psycnet.apa.org/doiLanding?doi=10.1037%2Ft3171
7-000. Accessed, 2011.
18. Martin MP, Rojas D, Dean CS, et al. Psychological outcomes
affect functional outcomes in patients with severe pelvic ring
fractures. Injury. 2021; 52(10):2750-2753.
http://dx.doi.org/10.1016/j.injury.2020.02.071
19. Duramaz A, Ilter MH, Yıldız Ş, Edipoğlu E, İpek C, Bilgili MG.
The relationship between injury mechanism and sexual
dysfunction in surgically treated pelvic fractures. Eur J
Trauma Emerg Surg. 2019; 46(4):807–16.
http://dx.doi.org/10.1007/s00068-018-01067-0
20. Metze M, Tiemann AH, Josten C. Male Sexual Dysfunction after
Pelvic Fracture. J Trauma Inj Infect Crit Care. 2007;
63(2):394–401.
http://dx.doi.org/10.1097/01.ta.0000241145.02748.df
21. Kroupa J. [Definition of "polytrauma" and
"polytraumatism"].Acta Chir Orthop Traumatol Cech. 1990;
57(4):347-60.
22. Kwan KSH, Roberts LJ, Swalm DM. Sexual dysfunction and
chronic pain: the role of psychological variables and impact
on quality of life. Eur J Pain. 2005; 9(6):643.
http://dx.doi.org/10.1016/j.ejpain.2004.12.008
23. Walton A, Leinwand G, Raheem O, Hellstrom W, Brandes S,
Benson C. Female Sexual Dysfunction After Pelvic Fracture: A
Comprehensive Review of the Literature. J Sex Med.2021;
18(3):467-473. doi: 10.1016/j.jsxm.2020.12.014.
24. Patel DN, Fok CS, Webster GD, Anger JT. Female urethral
injuries associated with pelvic fracture: a systematic review
of the literature. BJU Int. 2017; 120(6):766-773. doi:
10.1111/bju.13989. 
The Archives of Bone and Joint Surgery
Volume 11, Issue 4
April 2023
Pages 263-269

Files

History

  • Receive Date: 26 May 2021
  • Revise Date: 21 May 2022
  • Accept Date: 26 May 2022

Share

How to cite

Statistics